左双腔支气管导管插管深度的研究.docVIP

左双腔支气管导管插管深度的研究 王庆亮 张东 赵砚丽 张煜东 刘晓明 （河北省人民医院麻醉科，石家庄，050051） 通讯作者：赵砚丽 主任医师 教授 硕士生导师 【摘要】：目的 探讨合适的插管深度降低患者侧卧位后错位发生率及减轻错位程度。方法 选择成年胸科麻醉手术患者60例,静脉诱导后插入RobertshawDLT。在FOB 引导下将导管插入左主支气管,调整双腔管的位置将其随机分为三组: Ⅰ组:患者仰卧,头中立位,从气管腔侧插入FOB ,隆突在正前方清晰可见,调整导管使蓝色支气管套囊上缘正好在隆突下可见(充气后) ;然后从左支气管腔插入FOB ,可清晰看到左上叶支气管开口。Ⅱ组:基本上同Ⅰ组,不同之处在于: 将蓝色支气管套囊上缘调整在隆突下看不见; 从DL T 的左支气管腔插入FOB ,透过DL T 支气管管壁向右看并调整导管位置,使隆突正好位于蓝色支气管套囊上缘与左支气管腔壁上不透光黑线的正中央; III组:从气管腔侧插入FOB, 左支气管腔壁上不透光黑线正好在隆突下可见, 然后从左支气管腔插入FOB ,可清晰看到左上叶支气管开口。结果 据60例观测, ,DL T 位置重新调整率Ⅱ, III组明显低于Ⅰ组﹙p＜0.05﹚, Ⅱ,III组无差异（p≥0.05）.结论Ⅱ, III组插管深度明显降低患者侧卧位后错位发生率及减轻错位程度，插管深度位于Ⅱ, III组为合适的插管深度。 【关键词】 左双腔支气管 最适深度 纤维支气管镜 depth of the left Robertshaw double-lumen tube WANG Qing-liang ZHANG Dong ZHAO Yan-li ZHANG Yu-dong LIU Xiao-ming (The Hebei General Hospital, Hebei Shi jia zhuang , 050051，China ) 【Abstract】Objective To explore that suitable depth can reduce incidence of malpositioning from the supine to the lateral decubitus position. Methods Under genral anesthesia, 60 adult petients undergoing thoracic surgery were intubated with RobertshawDLTs. To adjust positioning of left double-lumen tube ,and randomly assign three groups: Ⅰgroup: In the supine Position, via the right tracheal lumen, the endoscopist should see a clear,straight-ahead view of the tracheal carina, It is important to see the upper surface of the left endobronchial blue cuff just below the carina, then looking down the left endobronchial lumen, the orifice of the LUL bronchus should be seen clearly. Ⅱgroup: The proximal shoulder edge of the blue bronchial cuff should not be visualized at the carina. However, through the left bronchial lumen,and by transparency across the wall of the tube, the position of the tube is adjusted so that the carina is midway between the black radiopaque line and the top of the bronchial cuff . Finally, the orifice of the LUL bronchus and the bronchial carina should be clearly seen. Ⅲgroup: via the right tracheal lumen, the black radiopaque line should be vis